Deinstitutionalization was supposed to be a way forward for America, getting people experiencing mental illness out of forced hospitalizations and back into communities. What partly led to this problem? In California, many cite Ronald Regan’s moves to deinstitutionalize in the late 1960s, and former Governor Jerry Brown’s effort to get people out of prison in the 1980s.
“Back in the 1960s, JFK was the one that really kicked off the deinstitutionalization movement in a brave way,” says Dr. Jonathan Sherin, former head of the Los Angeles County Department of Mental Health (LADMH). “But it required investment in the community. We all need communities, and we need inclusive communities. That would have required the development of adequate housing, as well as enterprise jobs, for example, which do exist in other parts of the world in a more robust way for those with disabilities … to bring people responsibly out of institutions and into communities.”
Nicole Eberhart, a behavioral scientist and clinical psychologist at RAND, says two factors led to the current crisis: “One is psychiatric bed shortages, and the other is criminalization of mental health. … We need more psychiatric beds, but we also need the right kinds of beds, less restrictive ones and community settings.”
Closing institutions without providing mental health services within the community led to what Eberhart refers to as the “criminalization of mental health.”
“Studies have found that at least 1 in 4 people with serious mental illness has a history of involvement with the criminal justice system. And this relates to the psychiatric bed shortages, because decreases in psychiatric beds are directly associated with increases in folks in jail. So we end up with a situation where correctional facilities are one of the larger providers of mental health care,” Eberhart notes. “Obviously this isn't an ideal care setting for recovery.”
Sherin believes a positive way forward is possible, but the state is decades behind. He has pushed for expanding the health workforce in a more inclusive way. “One of the things that I focused on my whole career is figuring out how to expand the workforce, not just with clinicians, but with individuals who have lived experience. We got a peer certification bill passed in the state of California that allows for us to use federal funding to pay for individuals with lived experience. You can imagine someone who has suffered from mental illness or addictions, who has been homeless, who has been otherwise system-involved at any point in their life — may not only need and benefit from opportunities to be employed and to develop a career, but can engage and provide the kind of support that people who are living on the streets need.”